Sessions and Presenters

Elder Justice: Congressional Action and Its Impact

Moderator: Robert B. Blancato, MPA, President, Matz, Blancato & Associates, Washington, DC. Presenters: Marie-Therese Connolly, JD, Coordinator, Elder Justice and Nursing Home Initiatives, U.S. Department of Justice, Washington, DC; Iris C. Freeman, MSW, Principal, Advocacy Strategy, Minneapolis, MN; Diane A. Menio, MS, Executive Director, Center for Advocacy for the Rights and Interests of Elderly, Philadelphia, PA.

Abstract
The focus of this symposium is the Elder Justice Act, landmark federal legislation that responds to the growing awareness of elder abuse, neglect, and exploitation across the country.

In the ideal, the moderator and panelists hope to make their presentations in the context of the Elder Justice Act's passage. Short of the ideal, they will provide up-to-date information about the status of the legislation and outline the steps to be taken in its cause.

Iris C. Freeman, Moderator, will begin with a brief overview of the goals and elements of the Elder Justice Act, and will identify the topics to be covered by the three main speakers.

Robert Blancato will focus on how the Elder Justice Act fared in the 108th Congress and the work to be done in the 109th. His segment will also highlight how the results of the 2004 elections are likely to affect advocacy and action on elder justice issues.

Marie-Therese Connolly will discuss the powerful potential of the legislation to improve the knowledge base for vulnerable adult protection through research and data collection; to safeguard individuals through the development of forensic centers and safe havens; to enhance law enforcement's capacity to address elder abuse; to expand professionals' training in pertinent areas; and to coordinate the work among agencies and disciplines.

Diane Menio will present the potential ramifications of the Elder Justice Act's passage or status for elder abuse prevention and response at the local and state level. As background, she will describe the work of CARIE across the spectrum of ombudsman casework, educational services, and public policy advocacy for the passage and implementation of Pennsylvania's Older Adults Protective Services Law.

Abuse, Neglect and Exploitation in Long-Term Care Facilities: Best Practice Approaches in Coordinating Investigations Involving Multiple Players

Presenters: Brandt Chvirko, MSW, MPA, Aging Services Program Specialist, Administration on Aging, Washington, DC; Becky A. Kurtz, JD, President, National Association of State Long-Term Care Ombudsman Programs (NASOP), Atlanta, GA; Joseph Snyder, MA, Director, Older Adult Protective Services, Philadelphia Corporation for Aging, Philadelphia, PA, and President, Board of the National Adult Protective Services Association; Sue Wheaton, MA, Ombudsman Program Specialist, Administration on Aging, Washington, DC.

Abstract During the past twenty to twenty-five years, two programs with statewide networks have developed to assist and serve as advocates for disabled and vulnerable adults:

1. The Long Term Care Ombudsman Program, which is charged under the Older Americans Act with advocating on behalf of older residents of long-term care facilities, and
2. Adult Protective Services (APS) programs, which are charged under State and/or county mandates with protecting vulnerable adults of any age, living in any setting.

Both networks -- as well as facility licensing and certification agencies in some states -- are responsible for receiving and investigating complaints involving mistreatment, neglect, abuse and exploitation of individuals who are vulnerable due to disability and often lack the means and capacity to protect themselves from harm. The two programs share important overall objectives and functions. Both programs seek to improve the quality of care and life of their clients; individuals working in both programs consider themselves to be advocates for the vulnerable people they serve; both programs seek to honor and protect the individual preferences and right to self-determination of those they serve. However, there are significant differences and distinctions in their history, stated missions, and statutory mandates. Also, staff of the two programs have distinct and different roles. As the ombudsman and APS networks have matured, program staff have realized that these issues of missions and roles require attention, understanding and "sorting through" in order to insure the maximum efficiency and effectiveness of both programs.

In October 1993 the U.S. Administration on Aging (AoA) convened a meeting on coordination between the ombudsman and adult protective services programs and related issues. The one-and-a -half-day meeting focused on o How the two programs could collaborate to better serve vulnerable older people; o Similarities and differences in mission, function and roles between the two programs; and o Related issues, including potential conflicts of interest, ombudsman confidentiality requirements and state mandatory abuse reporting laws; balancing protection and self-determination for clients; and definitions of abuse, neglect and exploitation for ombudsman reporting purposes. AoA widely disseminated a report on this meeting; copies are still requested today, usually from people in public agencies grappling with these issues. During the past decade, representatives of these networks have held discussions and collaborated on: cases; access to information, including confidentiality considerations; program location and resource sharing; guardianship and relocation of residents from facilities to the community and consumer-directed care The workshop will focus on best practice approaches in preventing abuse, neglect and exploitation and assisting victims developed as a result of this collaboration.

Consumer Choice in Healthcare: Elders Beware!

Presenters: Iris C. Freeman, MSW, Principal, Advocacy Strategy, Minneapolis, MN; Marshall B. Kapp, JD, MPH, Garwin Distinguished Professor of Law, Southern Illinois University School of Law, Carbondale, IL; Lisa Nerenberg, MSW, MPH, Consultant, Co-Investigator, National Study on Elder Abuse Multidisciplinary Teams, Redwood City, CA.

Abstract
This symposium will focus on the movement toward enhanced consumer choice in long term care. The preliminary findings of programs like the Department of Health and Human Services and the Robert Wood Johnson Foundation supported "Cash and Counseling" demonstration projects will be provided.

Among the choices many frail elders will make under consumer choice programs is deciding whether to purchase the services of Medicare-certified home health agencies or independently negotiating and contracting with independent personal care attendants. Proponents of consumer choice point to the enhanced autonomy and cost-savings, while skeptics question whether frail elders will be able to exercise informed choice, manage their own care, and withstand abuse and undue influence, pointing out the following obstacles:

• The shortage of affordable personal care attendants has meant that many elderly consumers rely on family members, friends or persons they find through advertisements to provide their care. This blurring of the lines between formal and informal care has posed troubling legal and ethical considerations. For example, as a result of effective lobbying by younger disabled persons, Minnesota recently amended its Vulnerable Adult Act to explicitly exempt consensual sexual relationships between personal care attendants and vulnerable adults from the definition of abuse and neglect. Other points of controversy include the extent to which third party payers can or should exercise control over caregiving relationships (e.g. consumers' right to hire family members with mental health problems or criminal histories).
• Lack of access to such critical information as whether potential health care providers have criminal records. While some states have passed laws permitting consumers to obtain criminal background checks for prospective home care employees, these laws are being challenged on constitutional grounds. Those that permit background checks typically fail to provide adequate guidance to consumers about how to use background checks in making hiring decisions. Criminal background checks also fail to provide relevant information about abuse histories that did not result in criminal action.
• Consumer choice requires that consumers be capable of exercising informed consent. Informed consent requires that persons have sufficient mental capacity to understand the benefits and risks of decisions they make. The specific mental skills that are needed for decision making is dictated by the type of decisions being made. While there is general agreement among legal professionals about how to define capacity for certain decisions (e.g. "testamentary capacity), standardized definitions do not exist for others, including decisions about the purchase of health care services.
• The network of community-based services designed to protect elders from abuse, neglect and exploitation by family members, unscrupulous businesses and predatory individuals include Adult Protective Services, Long Term Care Ombudsmen, daily money management programs, guardianship programs and others. The extent to which consumer choice will increase the demand for these services has not been adequately addressed.

Despite the serious protective service concerns that consumer choice raises, the issue has not been widely discussed either within the APS/elder abuse field or by those involved in consumer choice. This session will attempt to remedy the situation by initiating discussion and formulating key areas for further discussion, research, policy and deliberation.

Elder Abuse and the Media

Presenters: L. Rene Bergeron, PhD, Associate Professor, Social Work Department, University of New Hampshire, Durham, NH; Loree Cook-Daniels, MSCM, Executive Director, American Society of Adult Abuse Professionals & Survivors , Glendale, WI; Max Higgs, Judge of Statutory Probate Court, El Paso County Probate Court, El Paso, TX; Nancy Weaver Teichert, Senior Writer, Sacramento Bee, Sacramento, CA.

Abstract
More than 300 articles about elder or disabled adult abuse cases and topics are published each month in the United States. Some of these articles raise awareness of abuse, others scare or titillate people, and a few focus on scandals involving agencies trying to serve abused and at-risk elders.

This presentation is designed to raise awareness of what the media is covering with regard to elder abuse and give participants advice on how to interact with the media. A particular focus will be on encouraging participants to contact their local media outlets to initiate new and/or more accurate or complete articles on the subject and to include in their coverage specific information on how to prevent and report elder abuse. Reporters attending the workshop will gather many ideas for how they can effectively cover this important subject.

Elder Mistreatment: A Role for Physicians and the Healthcare Team

Presenters: Amy R. Eisenstein, MA, Education Coordinator, Section of Geriatric Medicine, Rush University Medical Center, Chicago, IL; Martin J. Gorbien, MD, FACP, Director, Section of Geriatric Medicine and Associate Director, Johnston R. Bowman Health Center, Rush University Medical Center, Chicago, IL; Maria R. Hansberry, MD, Assistant Professor of Internal Medicine, Section of Geriatric Medicine, Rush University Medical Center, Chicago, IL.

Pennsylvania's Enhanced Investigative Capacity Project to Address Financial Exploitation: Promoting Collaboration Between Adult Protective Services, Law Enforcement and Banks

Presenters: Brandt Chvirko, MSW, MPA, Aging Services Program Specialist, Administration on Aging, Washington, DC; Ronald W. Costen, PhD, Esq, Director, Institute on Older Adult Protective Services, Harrisburg, PA; Robert F. Hussar, Chief, Division of Consumer Protection, Pennsylvania Department of Aging, Harrisburg, PA; Linda S. Mill, Senior Vice President, Wachovia Corporation, Philadelphia, PA; Alan Smith, Director, Huntingdon-Bedford-Fulton Area Agency on Aging, Bedford, PA; Joseph Snyder, MA, Director, Older Adult Protective Services, Philadelphia Corporation for Aging, Philadelphia, PA, and President, Board of the National Adult Protective Services Association.

Abstract
In 2001, the Pennsylvania Department of Aging received funding from the U.S. Administration on Aging (AoA) for innovative projects designed to protect seniors from financial exploitation. The Department of Aging partnered with the Temple University Institute on Protective Services to develop and carry out the Enhanced Investigative Capacity Project. The Institute on Protective Services contracted with the Philadelphia Corporation for Aging and the Allegheny County Department of Aging (the area agencies on aging and APS agencies for each county) to hire and train a financial exploitation investigator with experience in fraud and financial crimes. These investigators provided training and consultation to APS workers, developed partnerships with law enforcement, and conducted in-depth investigations of exploitation crimes.

According to the National Elder Abuse Incidence Study, in 1996 financial abuse occurred in 30 percent of substantiated APS reports, higher than the incidence of physical abuse. The study also found that most victims of elder abuse, neglect and exploitation are 80+ years of age and suffer some degree of confusion. Over the next thirty years the number of seniors 85+ will triple to 8 million and those with Alzheimer's disease will grow from 4 million to 14 million by 2050.

Few perpetrators of elder exploitation are prosecuted or compelled to return stolen assets. Many APS agencies focus more on stopping exploitation than on making referrals to law enforcement, so many APS workers lack the training and mandate to investigate these crimes. Police and prosecutors are often unable or unwilling to pursue these cases on their own because of their complex and time-consuming nature. Even though banks are in an excellent position to stop exploitation, many are reluctant to become involved because of concerns about confidentiality and liability.

In Philadelphia and Allegheny Counties, neither APS agency had ever referred an exploitation case for prosecution. Since the inception of the Enhanced Investigative Capacity Project, the Philadelphia Corporation for Aging recovered or prevented the loss of nearly $1.4 million and referred nine cases for prosecution. It also developed a partnership with Wachovia Bank that resulted in a training program for bank personnel and increased sharing of records. Wachovia has since referred 112 cases to APS, which prevented the loss of over $450,000. The Allegheny County Department of Aging recovered or prevented the loss of nearly $500,000 and referred two cases for prosecution. The project also resulted in a regional task force made up of APS workers who specialize in exploitation cases, an APS peer consultation program, county-level multi-disciplinary teams, and duplication of the effort in Berks County, Pennsylvania. Most important, it raised the visibility of exploitation crimes and brought about a change in how APS agencies, law enforcement, and banks pursue them.

This workshop will describe the evolution of the Enhanced Investigative Capacity Project from its conceptual stage through implementation and duplication. An AoA representative will explain the federal role in promoting innovation and experimentation. Someone from the Pennsylvania Department of Aging will describe how the state selected the project and developed the partnerships necessary to carry it out. A representative from the Temple University Institute on Protective Services will describe the development of the project and the Institute's role in providing leadership and consultation to the APS agencies. Representatives from the Philadelphia Corporation for Aging and Wachovia Bank will describe their partnership, and someone from the Pennsylvania Association of Area Agencies on Aging will detail the plan for duplicating the project throughout the state.

Practice and Policy Implications of Elder Abuse Multidisciplinary Teams

Moderator: Susan J. Aziz, MA, Assistant Editor, Global Ageing, International Federation on Ageing, Boynton Beach, FL. Presenters: Pamela B. Teaster, PhD, Assistant Professor, Graduate Center for Gerontology, University of Kentucky, Lexington, KY; Lisa Gibbs, MD, Assistant Clinical Professor, Program in Geriatrics, Department of Family Medicine, and Medical Elder Abuse Multidisciplinary Team, University of California, Irvine, CA; Diana Koin, MD, Director, Elder Abuse Education, California Medical Training Center, University of California, Davis, CA; Lisa Nerenberg, MSW, MPH, Consultant, Co-Investigator, National Study on Elder Abuse Multidisciplinary Teams, Redwood City, CA.

Abstract
Elder abuse multidisciplinary teams (MDTs) include professionals from diverse disciplines who work together to review cases of elder abuse and address systemic problems. MDTs reflect the understanding that clinical and systemic issues often exceed the boundaries of any single discipline or agency. This session discusses findings from a national survey of elder abuse MDTs and highlights a death review team, a medically focused team, and a financial abuse specialist team. Participants of the specialist teams will discuss team functioning and practice and policy implications. These will include recommendations for funding, organization, maintenance of confidentiality, administration, continuity, and evaluation

Reforming the Texas Adult Protective Services System: Lessons for Other States' Advocates and Administrators

Presenters: Loree Cook-Daniels, MSCM, Executive Director, American Society of Adult Abuse Professionals & Survivors , Glendale, WI; Terry Hammond, Esq, Hammond & Associates, El Paso, TX; Max Higgs, Judge of Statutory Probate Court, El Paso County Probate Court, El Paso, TX; Gregg Phillips, Deputy Executive Commissioner for Social Services, Texas Health and Human Services Commission, Austin, TX.

Abstract
In early 2004, the El Paso (Texas) Adult Protective Services (APS) agency became the center of a very public controversy over what it was doing (and not doing) about elders living in unsanitary and/or dangerous conditions. A probate court judge and a guardianship lawyer helped fuel the effort by preparing and making public case studies of such repeat APS clients, and responding to media requests for more information. Within weeks, the Governor had demanded a high-level review of not only El Paso's office, but of the whole statewide APS system. How and why did the reform effort take hold so fast? What lessons can others who may want to improve or reform APS systems learn from what happened in Texas? What should administrators be considering if they are faced with such reform efforts? A panel of those involved in the Texas controversy will share what they learned about what to do (and not do) to provoke and/or respond to APS system reforms.

White House Conference on Aging Mini-Conference on Elder Abuse, Neglect and Exploitation

Presenters: Sara C Aravanis, Associate Director, National Center on Elder Abuse, Washington, DC; Susan J. Aziz, MA, Assistant Editor, Global Ageing, International Federation on Ageing, Boynton Beach, FL; Robert B. Blancato, MPA, President, Matz, Blancato & Associates, Washington, DC; Marie-Therese Connolly, JD, Coordinator, Elder Justice and Nursing Home Initiatives, United States Department of Justice, Washington, DC.

Elder Self-Neglect: Capacity to Consent Versus Right of Self Determination

Presenter: Georgia Veitch, MA, Detective/Crimes Against the Elderly, Hillsborough County Sheriff's Office, Tampa, FL.

Abstract
One of the biggest problems for law enforcement and Adult Protective Services (or any other responsible party) is to balance the elder's right of self determination with the needs and mores of the larger community. Although this appears to be an interesting philosophical question, it becomes very problematic when dealing with individual cases in which the elder is living in a compromised environment. Due to a diversity of life styles and cultural aspects, the elder may not recognize or may ignore their conditions (both environmentally and physically) due to a sense of independence, being over-whelmed by the environment, or reluctance to accept any intervention.

The community tends to become concerned when they view the adverse conditions. Law enforcement and/or Aging Services are notified in hopes of procuring intervention for the individual or to address the undesirable conditions. The question becomes: does the individual have capacity to consent to continue living in the noted conditions or does the individual's right of self determination prevail.

Understanding Self-Neglect: The Secret to Successful Interventions

Presenter: Paula McClain Mixson, LMSW-AP, CVW, Geriatric Consultant, Trainer, Certified Validation Worker, Austin, TX.

Abstract
Dealing appropriately with self-neglecting clients of questionable capacity who are at-risk due to untreated health conditions, environmental squalor, and extreme hoarding is a major challenge for aging services providers. Effective interventions require time, consummate social work skills, and productive linkages with resources in the community. This session will provide information for Adult Protective Services staff and other practitioners who want to increase their effectiveness in working with this challenging population.

Mixson will outline the physiological, medical, financial, social, psychological, and personal factors that can underlie self-neglect and illustrate perspectives and values among stakeholders in these cases. The workshop will describe interactive exercises that guide trainees to identify possible causes of self-neglect, competing values among stakeholders, and possible interventions, as well as provide resource information about working cases that involve extreme hoarding of animals and inanimate objects.

Although the inclusion of self-neglect as a category of adult/elder abuse has been debated within the elder abuse community for decades, self-neglect cases, i.e., vulnerable adults and elders with diminished capacity who are no longer able to meet their basic needs and have no one to help (or who refuse help) and are in danger, comprise the majority of the APS caseload in many states. Extreme hoarders of animals and inanimate objects that they treasure, but that may appear harmful or worthless to outsiders, form a subset of the self-neglect caseload that is typically very resistant to change. The demands of adult protective caseloads seriously inhibit successful interventions by APS workers, especially in cases of extreme self-neglect and hoarding. Increased public attention to self-neglect cases with negative, often fatal, outcomes has highlighted the training and resource needs of APS and other intervention programs. A pilot project in Boston, Massachusetts to provide crisis intervention and remedial services with animal hoarders illustrates the skills and resources that need to be supported by public policy and funding to enable successful interventions on a broader scale.

Forensic Examination for Elder Abuse Victims

Presenter: Diana Koin, MD, Director, Elder Abuse Education, California Medical Training Center, University of California, Davis, CA.

Abstract
California's new form for examination of elder abuse victims provides practitioners with a new tool. Use of a standardized form leads the examiner to be comprehensive and to consider multiple forms of simultaneous abuse. Documentation is enhanced by providing body diagrams to detail physical injury. The form includes functional and mental status screens to assist assessment of victim's limitations.

The form is useful for social service and health care professionals. Utilization of the form is a model other states may wish to adopt.

The Many Faces of Vulnerable Adult Abuse: Prevention and Remedies

Presenters: Kim R. Hubbard, BSL, JD, Coordinator of FAST; Elder Law Attorney, Council on Aging - Orange County, Santa Ana, CA; Susan Pederson, LCSW, Clinical Social Worker II, Older Adult Services, Santa Ana, CA; Carol Tryon, MSW, Elder Abuse Prevention Coordinator, Human Options, Inc., Irvine, CA.

Abstract
Program will identify forms of vulnerable adult abuse including advanced fee fraud schemes, organized transient criminal activity, random transient criminal activity, financial, emotional and physical abuse, domestic violence and sexual assault. Prevention strategies for all types will be addressed as well as civil legal remedies such as restraining orders, guardianships and civil litigation to recover assets. The feasibility of court action and access to the courts will also be discussed.

Tribal Approaches to Preventing Elder Abuse: Promising Practices for Indian Country and Beyond

Presenters: Dave Baldridge, Director, National Indian Project Center, Albuquerque, NM; William F. Benson, President, The Benson Consulting Group, Takoma Park, MD; Lisa Nerenberg, MSW, MPH, Consultant, Co-Investigator, National Study on Elder Abuse Multidisciplinary Teams, Redwood City, CA.

Abstract
Although little is known about elder abuse in Indian country, the existing literature and accounts by Indian elders and their families, tribes and advocates suggest that it is a serious and pervasive problem. The experiences of Indian elders with abuse, however, and their attitudes about what should be done.

New York State Elder Abuse Summit

Presenters: Art Mason, CSW, Director, Elder Abuse Prevention Program, Rochester, NY; Ken Onaitis, CSW, Director of Elder Abuse and Police Relations, Burden Center on Aging, New York, NY.

Abstract
The NY State Summit on Elder Abuse of May 2004, the only multi-day event modeled on the 2001 National Elder Abuse Summit, brought together 100 individuals from a variety of backgrounds to produce an Action Agenda to this nascent issue. This session will focus on 1.) the organization of the event, including how the Planning Committee, chosen from a variety of professional disciplines, was used to select diverse individuals from different geographic, ethnic and experiential backgrounds 2.) the event itself including the 6 workgroups, how they were identified and the method used to arrive at the final recommendations; the final recommendations themselves, including the top 6 of 18 chosen and 3.) how this process can be replicated by other states to develop their own Action Plan or Agenda.

Elder Abuse and Neglect: Maintaining Client and Family Relationships in a Mandated Reporting System

Presenters: Julie Lamberti, LCSW, Director, House of Welcome Adult Day Services, North Shore Senior Center, Northfield, IL; Marilyn Joan Vocker, LCSW, Director, Social Services, North Shore Senior Center, Northfield, IL.

Abstract
This session will focus on the challenges a professional encounters when mandated elder abuse and neglect reporting is the model. Concerns about minimizing the risk of victims while maintaining positive working relationships with families will be addressed. Adhering to legal mandates and professional licensing requirements while serving clients and families presents clinical dilemmas. These dilemmas will be demonstrated through case studies. The opportunity to share cases will be encouraged.

Aging Peter Pan

Presenter: Cathy J Cress, MSW, Director Professional Services, Northern California, Livhome, Campbell, CA.

Abstract
The workshop will cover the growing situation of aging sons and daughters in their 50's60's, who are often unemployed ,taking advantage of their old/old parents, through fiscal abuse including- both living in their parents homes and taking advantage of their elderly parents, fiscal resources.

Elder Abuse Perpetrators: Varying Profiles and Intervention Strategies

Presenter: Georgia J. Anetzberger, PhD, Consultant, Private Practice, and University Graduate Faculty, Cleveland State University, South Euclid, OH.

Older Women in Long-Term Care: A Population at Risk

Presenter: Elizabeth Podnieks, EdD, RN, Professor, School of Nursing, Ryerson University, Toronto, Ontario, Canada.

Abstract
Research has shown that older women can benefit from support groups, legal advocacy, safety planning, peer counseling and empowerment strategies. However, many older women, and on occasion professionals, are unaware that there are support services to help. The session describes a model which identifies and documents Best Practices on local service coordination, staff training, and public education initiatives that respond effectively to abused older women. This model can be used within institutions or in the community. It addresses the needs of both formal and informal caregivers as well as agencies that service older adults.

Family Violence in Later Life: A Collaborative Approach to Elder Abuse and Domestic Violence

Presenters: Kim R. Hubbard, BSL, JD, Coordinator of FAST; Elder Law Attorney, Council on Aging - Orange County, Santa Ana, CA; Susan Pederson, LCSW, Clinical Social Worker II, Older Adult Services, Santa Ana, CA; Carol Tryon, MSW, Elder Abuse Prevention Coordinator, Human Options, Inc., Irvine, CA.

Abstract
Family violence does not occur in a vacuum; neither should the services that are provided to the victims. Recently five agencies, all members of the Orange County Family Violence Council; Elder Abuse committee, have developed a collaborative approach in assisting the victims of elder abuse. The members include Orange County Adult Protective Services (APS) University of California Irvine, Vulnerable Adults Specialist Team (VAST), Orange County Health Care Agency, Older Adult Services (OAS), Orange County District Attorney's Office and Community Service Program: Elder Abuse Advocate, and Human Options. APS investigates reports of abuse that are referred to them from the community and mandated reporters. APS is the focal point that brings together the other key players to provide their expertise. VAST provides medical and mental status assessments in cases of alleged elder maltreatment. The assessments are used to evaluate abuse; assess the client's capacity to consent to the situation in question and to provide clarification and information to the referring party. OAS provides emergency/crisis mental health assistance through providing mental status assessments and the coordination of services. The Elder Abuse Advocate provides legal advocacy to victims prior, during, and after court appearances. Human Option's (a non-profit domestic violence organization) Elder Abuse Prevention Coordinator provides in-home counseling, legal advocacy, and case management services to the victims. The face of family violence is changing. We are seeing more cases of violence occurring in the home with victims who are considered healthy senior citizens. For many the violence has been a long-term pattern of abuse hidden from the outside world. With this collaborative intervention, services that might not otherwise be accessible are open to all victims that may need them. This presentation shows how collaboration between public and private organizations helps move victims of family violence from a place of hopelessness and helplessness to a place of hope and independence. It is suggest that social workers, case managers, mental health professionals, law enforcement officers, shelter and crisis center workers attend this presentation.

Intimate Partner Abuse and Older Women

Presenter: Lillian A. Colavecchio, MSS, ACSW, Program Specialist, Office of Elder Health, Massachusetts Department of Public Health, Boston, MA.

Abstract
Many older women suffer physical, sexual, emotional and financial abuse at the hands of spouses, partners, their families and others. Much attention has been directed to issues of elder abuse and neglect, but there has been virtual silence around the unique needs of older women living with domestic violence. Intimate partner abuse of older women is a real and growing problem. Johnetta Marshall, former President of the Older Women's League reported that in 1994, 1.4 million women in the United States between the ages of 45 to 65 were physically abused by their spouses. Even with these statistics, partner abuse of older women is considered to be underreported. Rape as part of this abuse is reported even less. The fact is that the abuse of older women by their spouses or partners is still a deeply held secret in families, neighborhoods and communities. It is a public health problem that is being addressed in Massachusetts by SAGE-Boston, a 23 member collaborative to end intimate partner abuse against older women.

SAGE-Boston brings together hospitals, domestic violence programs, visiting nurse associations, senior programs and others to improve how programs in the Boston area respond to women over the age of 60 who are abused by someone they love. Cross-trainings have been developed to build a shared language between domestic violence workers and senior services workers to improve services to older women. The trainings are co-presented by representatives from both networks.

This workshop will focus on 1) Raising awareness of the unique needs of older abused women 2) Identifying 4 prototypes of older abused women 3) Increasing collaboration between elder services and domestic violence workers 4) Differentiating intimate partner abuse from elder abuse 5) Understanding the differences between the caregiver stress model and the power and control model in responding to intimate partner abuse.

Older Women's Perceptions of Ethical Dilemmas in Adult Protective Services: An Exploratory Study

Presenter: Emily K. Dakin, PhD, MSSA, Assistant Director, San Francisco Consortium for Elder Abuse Prevention, Institute on Aging, San Francisco, CA.

Abstract
This study examined older women's perceptions of the definition of elder maltreatment and of three ethical dilemmas within Adult Protective Services: mandatory reporting and involuntary protective services (both of which illustrate the larger freedom versus protection dilemma); and the criminalization of elder maltreatment. Older women's ethical decision-making processes in responding to these dilemmas were also examined. An exploratory study was conducted utilizing a focus group design with a pilot focus group, eight focus groups, and a final member-check group. The eight focus groups were comprised of two working-class Caucasian groups, two working class-African American groups, one high socioeconomic status Caucasian group, one high socioeconomic status African American group, and two Latina groups. All of the study's 88 participants were women age 60 or older.

Participants espoused a broad definition of elder maltreatment that included physical neglect, emotional neglect, physical abuse, verbal abuse, financial abuse, societal maltreatment, maltreatment by family and strangers, and abuse within nursing homes. In responding to scenarios illustrating the study's dilemmas, participants overwhelmingly favored protection over freedom (that is to say, favored mandatory reporting and involuntary protective service provision), and strongly favored the criminalization of elder maltreatment. Participants also emphasized the importance of prevention and early intervention in elder maltreatment cases, and the need for friends and family to take responsibility in helping to intervene in these cases. Latina participants emphasized the importance of family in responding to these dilemmas, and were particularly familiar with and tolerant of domestic violence. Caucasian participants placed less of an emphasis on verbal abuse in their definition of maltreatment than did the other groups, while African American participants held particularly favorable views towards intervening in the discussed scenarios. The high socioeconomic focus groups were the only groups to discuss the value of freedom in the freedom/protection dilemma.

This research indicating public support for protective interventions should eventually be replicated using statistical methods and a larger, probability sample. Continued evidence of public support for these interventions warrants consideration by APS practitioners and policy makers who struggle with their ethical dimensions. Potential implications include the value of expanding mandatory reporting requirements, the need for education about non-ageism and individual rights, and the need for culturally specific education about domestic violence in late life.

Rates of and Risk Factors for Elder Abuse in Japan and the United States

Presenters: Tokie Anme, PhD, Professor of Community Care and Management, Hamamatsu University School of Medicine, Shizuoka, Japan; Mary McCall, PhD, Professor of Psychology, St. Mary's College, Moraga, CA.

Abstract
The purpose of this study was to examine preliminary data on rates and risk factors for elder abuse and neglect from a community in Japan, and compare those data with previous research conducted in the United States. The goal is to begin to understand the context for abuse and neglect of elderly persons in Japan and how to address those problems most effectively. While elder abuse and neglect have been more commonly studied over the last 30 years in the U.S., they have only recently begun to be investigated in Japan. Traditionally, Japan has had a family-based caregiving system, and the character of that relationship has remained relatively private and respected as such. For example, typically the eldest son's spouse would be the caregiver of her in-laws, often against her wishes. However, with major cultural changes occurring, especially in more urban areas of Japan, however, caregiving is shifting from that family model to a more formal, community-based caregiving system. With the advent of "outsiders" now being involved in the care of elders, the incidence of abuse and neglect is becoming more noticeable and calls for greater attention from service providers and family and community member alike. Understanding the rates of abuse and neglect, as well as what factors increase the risk of these occurring, will enable service providers and policymakers alike to address the problems more effectively. Comparing data recently gathered in Japan with much of the previous research done in the U.S. should help clarify what risk factors are common across the two cultures, and what variables may be culturally specific to each.

The Japanese respondents were all frail elderly (n=78), 60 years of age or older, in an agricultural village with an industrial seashore (total population =4,702). The community is near a large urban center on the main island of Japan. A survey was conducted of all the frail elderly in the community who received any kind of care-related services (n=1,134) and was performed during a home visit. Information gathered during the interview included: a) kinds of frequency of abuse/neglect (i.e., physical, sexual, emotional/psychological, financial or substance, neglect or self-neglect); b) demographic data (i.e., age, gender, marital status, family structure, SES); c) physical and mental condition of the elder (i.e., ADLs, senility, social role engagement and behavioral problems; and d) physical and mental condition of the caregiver (i.e., health status, ability to understand the nature of aging, experience of role conflict, level of care burden, and support from other family members).

Of the 78 frail elderly who were interviewed, fourteen persons were found to have been abused (17.9%). Of these, 78.6% were female, and the average age was 80.3 for abused men and 81.2 for abused women. This was significantly different from the average age of non-abused men (75.4) and women (80.1). Eight of the fourteen abused persons were females, 75 years of age or older. This rate is several times higher than the rates found in the U.S., where some studies report between 3 and 4% was maltreated (Lachs, et al., 1994; Tatara, 1998). However, these studies included healthy elders. Studies that examined samples of frail elderly reported rates of abuse between 10 and 20% (Lau and Kosberg; 1979, Reis, 2000; Wolfe, 2000). Thus, rates of abuse among frail elderly seem to be similar in both countries.

Fifty percent of the caregivers were daughters-in-law, while 25.9% were wives, 14.8% were husbands and 7.4% were daughters. Nearly two-thirds (64.3%) of the abusers were daughters-in-law. The average of the abusers was significantly younger than the non-abusers. The average age of male abusers was 72.0, while the non-abusers were, on average, 75.9 years old. Similarly, the average age of the female abusers was 59.2, while the non-abusers were 61.6 years of age on average. A study of abuse in Pennsylvania in the 1999-2000 year found that the most common abusers were family members (59%), with them most often being a 30-59-year-old male family member. This is unlike Japan, where the most common abusers were daughters-in-law. Interestingly enough, in the Pennsylvania study, fully 39% of the identified abusers were unrelated to the victim (Pennsylvania State Department on Aging, 2003).

The most common type of abuse found in the Japanese study was emotional/psychological, followed by neglect and physical abuse. Twelve of the fourteen persons (85.7%) suffered from multiple abuses. This is somewhat different from the Pennsylvania study, which found 25% of the substantiated reports of abuse to be assault of various types (physical, sexual, etc.) and 12.3% to be financial. Similarly, however, they found that most victims suffered from multiple abuses (Pennsylvania State Department on Aging, 2003). A study conducted in the U.S. in 1988 (Pillemer and Finkelhor) reported that two-thirds of abuse cases were physical, followed by verbal abuse.

In the Japanese sample, the ratio of dependency in ADLs was significantly higher among those who were abused (57.1%) than those who were not abused (32.8%). Interestingly, 35.7% of the abused were senile, compared to only 10.9% of the non-abused. Further, 57.1% of the abused had lost their social roles, compared to only 17.1% of those not abused. Those who were abused also had behavioral problems. The abusing caregivers had more health problems the non-abusers, they were more likely to misunderstand the elder's conditions, and they received less family support than non-abusers.

Controlling for age and sex, the risk of abuse was higher for frail elderly who were senile, had lost their social roles, were incontinent, wandered, or were having sensory disorders. The odds of being abused by different caregivers increased for daughters-in-law, caregivers who had health problems themselves, caregivers who misunderstood elders' conditions, those who felt a serious care burden, those who did not receive much family support, or those who had family members living in other places. Three variables were identified as major predictors of abuse: wandering due to senility, caregiver health problems, and caregiver's misunderstanding of elders' conditions. Some of these risk factors are similar to those found in the United States across various studies. For example, Fulmer, et al. (2003) found that ADL dependency, caregiver health problems, caregiver misunderstanding of the elder's conditions, and little family support were risk factors for abuse. In addition, Reis (2000) found that the caregiver's misunderstanding was a major risk factor for abuse, while Pillemer (1992) concluded that senility of the elder increased abuse risk.

There are no data on the prevalence of domestic elder abuse in Japan. This preliminary study found 17.9% of respondents were abused. This study also found higher rates of emotional/psychological abuse (50% in this study) than previous studies in Japan (Takasaki, et al., 1995; Tanaka, 1995) because cases that had not yet officially been reported were uncovered during these home visits. Although these data are very preliminary, they point to some key considerations in efforts to prevent elder abuse. These are similar to efforts made in the United States First, it is clearly important to provide education and support for caregivers so that they truly understand the circumstances of the person for some they are providing care. This kind of understanding may go a long way in preventing abuse based on frustration and misunderstanding. This includes especially education about dementia and other cognitive deficits. The role of social support for caregivers is also crucial - both from other family members and perhaps from more formal, community-based sources as well. As Japan begins to uncover and address elder abuse, these kinds of preventive services can hopefully be integrated into public health approaches that community health centers provide. Support for caregivers should also include addressing the caregivers' health concerns/problems, as well as efforts to slow the rate of functional decline in the person being cared for. The goal of optimal health for both caregiver and recipient will aid both in facing the challenges of aging within families, whatever the cultural context.

Older Battered Woman or Victim of Elder Abuse?

Presenter: Carol Tryon, MSW, Elder Abuse Prevention Coordinator, Human Options, Inc., Irvine, CA.

Abstract
Safe Options for Seniors is one of only a few domestic violence programs in the United States specifically developed to meet the needs of this population. In 2003 this program received Disney's "Outstanding Community Service Program" and was nominated for the Rosalie Wolf Memorial Award. This presentation will cover normal aging issue of older victims; stereotypical beliefs and societal norms that effect working with older victims and the successful interventions this program had developed. In addition it will look to the future to what services are still needed. We now recognize family violence in later life as a major issue for seniors. Looking back at the history of the domestic violence movement we now see that many of our older battered women are the same women for whom the domestic violence movement was started now these women are the forgotten victims. Many county and private agencies, which have members attending this conference, are trying to develop programs and services to assist these victims. These interventions can be used in almost any setting and with a variety of clients. The intended audience is senior service providers, domestic violence staff, and legal professionals and paraprofessionals. This program is unique for several reasons. It is a program that was especially developed for older victims. Safe Options for Seniors, all though only been open for three years has a 90% success rate in assisting victims living violence-free lives. For older victims even one year is a lifetime of success.

Psychological Abuse of the Vulnerable and Elderly

Facilitator: Gretchen Scheffel, MSW, Aging Consultant, Circle of Life Aging Services, St. Paul, MN.

Senior Financial Scams

Facilitator: Thomas R. Lee, President, Senior Law Centers of America, West Hills, CA.

Abstract
Every year seniors are scammed and cheated out of their hard earned money. These malicious scams rob seniors of their trust, their security and their financial future. Scamming seniors is a widespread problem that covers every state and affects the diverse senior population. Senior Resources of America (SROA) realizes the importance of protecting seniors and their families from these scams so seniors can live an independent and secure life. SROA will discuss the typical victim, who is most likely to abuse seniors and how to protect seniors with the assistance of a panel of experts in the field.

SROA will discuss who is most at risk of being a victim to these scams. Scams do not discriminate. Seniors can be vulnerable to quick fixes, a fast return on investments and in their caring nature, believe that a donation will help their community, religious organizations or person in need. The victims of these scams are found across a broad spectrum of financial standing without regard to gender, nationality or ethnicity. SROA will discuss how scams manipulate each demographic and community.

SROA will help focus in on who is doing the abusing. These perpetrators range from financial planners, telemarketers, direct mail pieces, people claiming to be in the religious community and insurance agents. The top 10 most common schemes are: o Ponzi Schemes o Senior Investment Fraud o Promissory Notes o Unscrupulous brokers o Affinity Fraud o Insurance Agent Securities Fraud o Prime Bank o Internet Fraud o Mutual Fund Business Practices o Variable Annuities. The scammers manipulate people by getting them to send cash and provide personal information such as social security numbers. Seniors are offered inducement in the form of prizes, cash, and large return on an investment but in reality it is a ploy to get at hard earned money.

Our final section of the presentation will cover resources to help seniors affected by such scams. With the help of our panel of experts, we will discuss ways to help victims and how to educate others with regard to these issues.

Seniors need to be proactive. Before they invest or give money to any person, business or organization, seniors need to research in order to protect their assets. All seniors are at risk without any emphasis on cultural background, ethnicity, gender, sexual orientation, values or experience.

Stop It Before It Starts: Best Practices in Elder Abuse Prevention

Facilitators: Loree Cook-Daniels, MSCM, Executive Director, American Society of Adult Abuse Professionals & Survivors, Glendale, WI; Mitchell Karasov, JD, Owner, The Elder Law Offices of Mitchell A Karasov, North Hollywood, CA; Anita H. Miller, MA, GCM, Director of Geriatric Planning, The Elder Law Offices of Mitchell A. Karasov, North Hollywood, CA.

Abstract
Aging professionals often talk about elder abuse prevention, but remarkably little exists in the field on what people can actually do to protect themselves. This workshop will focus on two types of best practices: legal, social, psychological, and other measures people can take to protect themselves or their loved ones from abuse, and community-based programs that seek to prevent abuse through the provision of some type of direct services to at-risk elders. An emphasis will be placed on how aging professionals can find free prevention materials. The focus will be on preventing domestic elder abuse, although participants' favorite tips on preventing institutional abuse will also be welcomed during the part of the presentation that focuses on audience members' favorite techniques.

Understanding Physical Elder Abuse - Who is at Risk, Identifying the Abuse and Learn How to Help

Facilitator: Thomas R. Lee, President, Senior Law Centers of America, West Hills, CA.

Abstract
How comfortable do you feel leaving a loved-one in a nursing home or with a caregiver? A family should feel at ease knowing that their relative is taken care of in a safe setting to keep them healthy and happy. There have been situations where a nursing home or caregiver may not meet the standards resulting in bodily harm, illness or even death. In order to increase provider revenues, nursing home care decisions are frequently made with an eye to bottom line profits, not on quality patient care and compassionate. This practice of Utilization Manipulation, which cuts across all income levels, races and geographic regions, is especially devastating to women since they make up the larger percentage of patients.

In a result of poorly operated nursing home facilities and caregivers, both physical and financial abuse can take place. Senior Resources of America (SROA), along with a panel of experts in the field, will discuss the types of abuse in these facilities. These range from: o Assault o Battery o Psychological o Sexual Abuse o Neglect o Other related abuse cases.

SROA will highlight the options and resources to help the victims in the nursing home facility or with a caregiver.